Cost-effectiveness of a bivalent human papillomavirus vaccination program in Japan
Luke B. Connelly A C and Ha N. D. Le B
+ Author Affiliations
- Author Affiliations
A The University of Queensland, Faculty of Health and Behavioural Sciences, Level 7, Oral Health Building, Herston, Qld 4006, Australia.
B Deakin Health Economics, Population Health SRC, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Vic. 3125, Australia.
C Corresponding author. Email: l.connelly@uq.edu.au
Sexual Health 12(6) 520-531 https://doi.org/10.1071/SH14241
Submitted: 18 December 2014 Accepted: 17 June 2015 Published: 28 September 2015
Abstract
Background: Human papillomavirus (HPV) vaccines and their widespread adoption have the potential to relieve a large part of the burden of cervical cancer morbidity and mortality, particularly in countries that have low screening rates or, like Japan, lack a cohesive universal screening program. An economic evaluation was conducted to assess the cost-effectiveness of introducing a bivalent HPV vaccination program in Japan from a healthcare perspective. Methods: A Markov model of the natural history of HPV infection that incorporates both vaccination and screening was developed for Japan. The modelled intervention, a bivalent HPV vaccine with a 100% lifetime vaccine efficacy and 80% vaccine coverage, given to a cohort of 12-year-old Japanese girls in conjunction with the current screening program, was compared with screening alone in terms of costs and effectiveness. A discount rate of 5% was applied to both costs and utilities where relevant. Results: Vaccination alongside screening compared with screening alone is associated with an incremental cost-effectiveness ratio (ICER) of US$20 315 per quality-adjusted-life-year gained if 80% coverage is assumed. The ICER at 5% coverage with the vaccine plus screening, compared with screening alone, is US$1158. Conclusion: The cost-effectiveness results suggest that the addition of a HPV vaccination program to Japan’s cervical cancer screening program is highly likely to prove a cost-effective way to reduce the burden of cervical cancer, precancerous lesions and HPV16/18-related diseases.
Additional keywords: cervical cancer, HPV, screening, vaccine.
References
[1] zur Hausen H. Papillomavirus infections–a major cause of human cancers. Biochim Biophys Acta 1996; 1288 F55–78.| 8876633PubMed |
[2] World Health Organization. Comprehensive cervical cancer control: a guide to essential practice 2006. Geneva: World Health Organization; 2007.
[3] Iwasaka T, Matsuo M, Yokoyama M, Uchiyama M, Fukuda K, Sugimori H. Propspective follow-up of Japanese women with cervical intraepithelial neoplasia and various human papillomavirus types. Int J Gynaecol Obstet 1998; 62 269–77.
| Propspective follow-up of Japanese women with cervical intraepithelial neoplasia and various human papillomavirus types.Crossref | GoogleScholarGoogle Scholar |
[4] Miura S, Matsumoto K, Oki A, Satoh T, Tsunoda H, Yasugi T, Taketani Y, Yoshikawa H. Do we need a different strategy for HPV screening and vaccination in East Asia? Int J Cancer 2006; 119 2713–5.
| Do we need a different strategy for HPV screening and vaccination in East Asia?Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD28XhtFygur%2FE&md5=8403ecba4cc2b72daa6a687653366022CAS | 16929495PubMed |
[5] Ioka A, Tsukuma H, Ajiki W, Oshima A. Influence of age on cervical cancer survival in Japan. Jpn J Clin Oncol 2005; 35 464–9.
| Influence of age on cervical cancer survival in Japan.Crossref | GoogleScholarGoogle Scholar | 16006573PubMed |
[6] Konno R, Shin HR, Kim YT, Song YS, Sasagawa T, Inoue M, Park J-S. Human papillomavirus infection and cervical cancer prevention in Japan and Korea. Vaccine 2008; 26 M30–42.
| Human papillomavirus infection and cervical cancer prevention in Japan and Korea.Crossref | GoogleScholarGoogle Scholar | 18945412PubMed |
[7] Harper DM, Franco EL, Wheeler C, Ferris DG, Jenkins D, Schuind A, Zahaf T, Innis B, Naud P, De Carvalho NS, Roteli-Martins CM, Teixeria J, Blatter MM, Korn AP, Quint W, Dubin G. Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomised controlled trial. Lancet 2004; 364 1757–65.
| Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2cXpslGju78%3D&md5=40ae4266c6ebfa841ed6946de89d4213CAS | 15541448PubMed |
[8] Shimazawa R, Ikeda M. The vaccine gap between Japan and the UK. Health Policy 2012; 107 312–7.
| The vaccine gap between Japan and the UK.Crossref | GoogleScholarGoogle Scholar | 22727579PubMed |
[9] Wilson R, Paterson P, Larson HJ. The HPV vaccination in Japan. . A report of the CSIS Global Health Policy Center. Washington: Center for Strategic & International Studies; 2014.
[10] World Health Organization. Global Advisory Committee on Vaccine Safety, report of a meeting held 12–13 June 2013.Geneva: World Health Organization; 2013. Available online at: http://www.who.int/vaccine_safety/committee/reports/Jun_2013/en/ [verified 19 May 2015].
[11] Abma JC, Sonenstein FL. Sexual activity and contraceptive practices among teenagers in the United States, 1988 and 1995. Vital Health Stat 23 2001; 21 1–79.
| 11478202PubMed |
[12] Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson H, Unger ER. Quadrivalent human papillomavirus vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2007; 56 1–24.
| 17380109PubMed |
[13] Kulasingam S, Connelly L, Conway E, Hocking JS, Myers E, Regan DG, Roder D, Ross J, Wain G. A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical Cancer Screening Program. Sex Health 2007; 4 165–75.
| A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical Cancer Screening Program.Crossref | GoogleScholarGoogle Scholar | 17931529PubMed |
[14] Munoz N, Bosch FX, de Sanjose S, Herrero R, Castellsague X, Shah KV, Snijders PJF, Meijer CJLM. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med 2003; 348 518–27.
| Epidemiologic classification of human papillomavirus types associated with cervical cancer.Crossref | GoogleScholarGoogle Scholar | 12571259PubMed |
[15] Inoue M, Sakaguchi J, Sasagawa T, Tango M. The evaluation of human papillomavirus DNA testing in primary screening for cervical lesions in a large Japanese population. Int J Gynecol Cancer 2006; 16 1007–13.
| The evaluation of human papillomavirus DNA testing in primary screening for cervical lesions in a large Japanese population.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28zoslejsg%3D%3D&md5=ef8c7cd49a8aa5210178eeb89af767b8CAS | 16803477PubMed |
[16] Kulasingam SL, Benard S, Barnabas RV, Largeron N, Myers ER. Adding a quadrivalent human papillomavirus vaccine to the UK cervical cancer screening programme: a cost-effectiveness analysis. Cost Eff Resour Alloc 2008; 6 4
| Adding a quadrivalent human papillomavirus vaccine to the UK cervical cancer screening programme: a cost-effectiveness analysis.Crossref | GoogleScholarGoogle Scholar | 18279515PubMed |
[17] Myers E, McCrory D, Nanda K, Bastian L, Matchar D. Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis. Am J Epidemiol 2000; 151 1158–71.
| Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3czmtFClsQ%3D%3D&md5=30e2e794918b907598d2afb3129984c6CAS | 10905528PubMed |
[18] Canfell K, Barnabas R, Patnick J, Beral V. The predicted effect of changes in cervical screening practice in the UK: results from a modelling study. Br J Cancer 2004; 91 530–6.
| The predicted effect of changes in cervical screening practice in the UK: results from a modelling study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2czns1Crsg%3D%3D&md5=c13b9b99c9108366e549814c1ee31bf3CAS | 15266332PubMed |
[19] Yokoyama M, Iwasaka T, Nagata C, Nozawa S, Sekiya S, Hirai Y, Kanazawa K, Sato S, Hoshiai H, Sugase M, Kawana T, Yoshikawa H. Prognostic factors associated with the clinical outcome of cervical intraepithelial neoplasia: a cohort study in Japan. Cancer Lett 2003; 192 171–9.
| Prognostic factors associated with the clinical outcome of cervical intraepithelial neoplasia: a cohort study in Japan.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD3sXisV2mtrk%3D&md5=ab34821b98d3f4eb83f4ee10ebdb5319CAS | 12668281PubMed |
[20] Ostror AG. Natural history of cervical intraepithelial neoplasia: critical review. Int J Gynecol Pathol 1993; 12 186–92.
| Natural history of cervical intraepithelial neoplasia: critical review.Crossref | GoogleScholarGoogle Scholar |
[21] Onuki M, Matsumoto K, Satoh T, Oki A, Okada S, Minaguchi T, Ochi H, Nakao S, Someya K, Yamada N, Hamada H, Yoshikawa H. Human papillomavirus infections among Japanese women: age-related prevalence and type-specific risk for cervical cancer. Cancer Sci 2009; 100 1312–6.
| Human papillomavirus infections among Japanese women: age-related prevalence and type-specific risk for cervical cancer.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1MXosl2kur8%3D&md5=af920639f1221b377b8b1d074d47c0b4CAS | 19432906PubMed |
[22] Sasagawa T, Basha W, Yamazaki H, Inoue M. High-risk and multiple human papillomavirus infections associated with cervical abnormalities in Japanese women. Cancer Epidemiol Biomarkers Prev 2001; 10 45–52.
| 1:STN:280:DC%2BD3M7nvVyjsQ%3D%3D&md5=c4446c0286ded0f6c683a6afcaa318b3CAS | 11205488PubMed |
[23] National Cancer Center. Cancer statistics in Japan 2008. Survival rate in the member hospitals of the Association of Clinical Cancer Centers (diagnosed in 1997–2000). Available online at: http://ganjoho.ncc.go.jp/public/statistics/backnumber/odjrh3000000vdf1-att/date07.pdf2008 [verified 7 May 2011].
[24] National Cancer Center. Cancer statistics in Japan 2005–2007. Cancer mortality by age and site. 2007. Available online at: http://ganjoho.jp/pro/statistics/en/backnumber/2013_en.html [verified 15 October 2009].
[25] Human Mortality Database. Japan – background and documentation. Available online at: http://www.mortality.org/cgi-bin/hmd/country.php?cntr=JPN&level=1 [verified 15 October 2009].
[26] Curran DR, Stigleman S, Neher JO. Should we discontinue screening in women aged >65 years? J Fam Pract 2004; 53 308–10.
| 15068776PubMed |
[27] Fujii T, Takehara T, Ohta S, Okamura C, Nishino Y, Yajima A. Increased incidence of uterine cervical cancer in young women in Hiroshima prefecture: necessity of performing uterine cancer screening for women under 29 years old. J Jpn Assoc Cancer Detect 2003; 11 86–91.
[28] Yamamoto N, Mori R, Jacklin P, Osuga Y, Kawana K, Shibuya K, Taketani Y. Introducing HPV vaccine and scaling up screening procedures to prevent deaths from cervical cancer in Japan: a cost‐effectiveness analysis. BJOG 2012; 119 177–86.
| Introducing HPV vaccine and scaling up screening procedures to prevent deaths from cervical cancer in Japan: a cost‐effectiveness analysis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC38%2FlvVGhtw%3D%3D&md5=e41b4e65ae75ac3ac274138ceaac40b0CAS | 21794070PubMed |
[29] Bodner K, Bodner-Adler B, Wierrani F, Kimberger O, Denk C, Grunberger W. Is therapeutic conization sufficient to eliminate a high-risk HPV infection of the uterine cervix? A clinicopathological analysis. Anticancer Res 2002; 22 3733–6.
| 12552985PubMed |
[30] De Carvalho N, Roteli C, Naud P. Immunogenicity and safety of HPV 16/18 AS04 adjuvanted vaccine up to 7.3 years. Abstract presented at 25th International Papillomavirus Conference, 8–14 May 2009, Malmo, Sweden. Malmo: International Papillomavirus Society; 2009.
[31] Kohli M, Ferko N, Martin A, Franco EL, Jenkins D, Gallivan S, Sherlaw-Johnson C, Drummond M. Estimating the long-term impact of a prophylactic human papillomavirus 16/18 vaccine on the burden of cervical cancer in the UK. Br J Cancer 2007; 96 143–50.
| Estimating the long-term impact of a prophylactic human papillomavirus 16/18 vaccine on the burden of cervical cancer in the UK.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2s%2Fhs1Oiuw%3D%3D&md5=2915944edd7e4ebc13ca2a7e87ecf764CAS | 17146475PubMed |
[32] Fukuda T. Cost effectiveness of HPV vaccination in Japan. HPV vaccination policy in different setting: any role of HTA evidence. Abstract presented at the six annual meeting of HTAi. Singapore: Health Techonology Assessment international; June 2009.
[33] Matsunaga G, Tsuji I, Sato S, Fukao A, Hisamichi S, Yajima A. Cost-effective analysis of mass screening for cervical cancer in Japan. J Epidemiol 1997; 7 135–41.
| Cost-effective analysis of mass screening for cervical cancer in Japan.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2svnvVKlug%3D%3D&md5=21a8f389a21fa83dbb942b856a22dcb5CAS | 9337511PubMed |
[34] Konno R, Sasagawa T, Fukuda T, Van Kriekinge G, Demarteau N. Cost-effectiveness analysis of prophylactic cervical cancer vaccination in Japanese women. Int J Gynecol Cancer 2010; 20 385–92.
| Cost-effectiveness analysis of prophylactic cervical cancer vaccination in Japanese women.Crossref | GoogleScholarGoogle Scholar | 20375802PubMed |
[35] Myers ER, Green S, Lipkus I. Patient preferences for health states related to HPV infection. Proceedings of the 21st International papillomavirus Conference. Mexico City, Mexico. Mexico City: International Papillomavirus Society; 2004.
[36] Matsuda T, Marugame T, Kamo K, Katanoda K, Ajiki W, Sobue T. Cancer incidence and incidence rates in Japan in 2003: based on data from 13 population-based cancer registries in the Monitoring of Cancer incidence in Japan (MCIJ) project. Jpn J Clin Oncol 2009; 39 850–8.
| Cancer incidence and incidence rates in Japan in 2003: based on data from 13 population-based cancer registries in the Monitoring of Cancer incidence in Japan (MCIJ) project.Crossref | GoogleScholarGoogle Scholar | 19797417PubMed |
[37] Goldie S, Kim J, Wright T. Cost-effectiveness of human papillomavirus DNA testing for cervical cancer screening in women aged 30 years or more. Obstet Gynecol 2004; 103 619–31.
| Cost-effectiveness of human papillomavirus DNA testing for cervical cancer screening in women aged 30 years or more.Crossref | GoogleScholarGoogle Scholar | 15051550PubMed |
[38] World Health Organization. Statistical information system. CHOICE (Choosing Interventions that are Cost Effective). Available online at: www.who.int/choice/en/ [verified 29 January 2008].
[39] Brisson M, Van de Velde N, Boily MC. Economic evaluation of human papillomavirus vaccination in developed countries. Public Health Genomics 2009; 12 343–51.
| Economic evaluation of human papillomavirus vaccination in developed countries.Crossref | GoogleScholarGoogle Scholar | 19684446PubMed |
[40] Mubiayi N, Bogaert E, Boman F, Leblanc E, Vinatier D, Leroy JL, Querleu D. Cytological history of 148 women presenting with invasive cervical cancer. Gynecol Obstet Fertil 2002; 30 210–7.
| Cytological history of 148 women presenting with invasive cervical cancer.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD383mtVegtQ%3D%3D&md5=da7a5927b8871a8c7a30aa8e9f3019c4CAS | 11998209PubMed |
[41] Jit M Chapman R Hughes O Choi YH .
[42] Gilmour S, Kanda M, Kusumi E, Tanimoto T, Kami M, Shibuya K. HPV vaccination programme in Japan. Lancet 2013; 382 768
| HPV vaccination programme in Japan.Crossref | GoogleScholarGoogle Scholar | 23993189PubMed |
